Impact of SGLT2-inhibitors on contrast-induced acute kidney injury in diabetic patients with acute myocardial infarction with and without chronic kidney disease: Insight from SGLT2-I AMI PROTECT registry

Paolisso, Pasquale; Bergamaschi, Luca; Cesaro, Arturo; Gallinoro, Emanuele; Gragnano, Felice; Sardu, Celestino; Mileva, Niya; Foà, Alberto; Armillotta, Matteo; Sansonetti, Angelo; Amicone, Sara; Impellizzeri, Andrea; Belmonte, Marta; Esposito, Giuseppe; Morici, Nuccia; Oreglia, Jacopo; Casella, Gianni; Mauro, Ciro; Vassilev, Dobrin; Galiè, Nazzareno; Santulli, Gaetano; Calabrò, Paolo; Barbato, Emanuele; Marfella, Raffaele; Pizzi, Carmine

doi:10.1016/j.diabres.2023.110766

Cited by 32 publications

(16 citation statements)

References 31 publications

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“… 28 In a recent multicenter registry, it was shown in a cohort with ACS that the rate of CA-AKI was significantly lower in patients with DM who were using an SGLT2 inhibitor compared to non-users. 29 This trial was published while we were analyzing our findings, and we found similar results. We also analyzed the duration of hospitalization in addition to their findings.…”

Section: Discussionsupporting

confidence: 78%

Do Sodium-Glucose Cotransporter 2 Inhibitors Decrease the Risk of Contrast-Associated Acute Kidney Injury in Patients with Type II Diabetes Mellitus?

Çabuk

2024

Anatol J Cardiol

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Background: The risk of contrast-associated acute kidney injury is relatively higher in patients with diabetes mellitus compared to non-diabetics. Recent trials have revealed the renoprotective effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors. We aimed to investigate the possible preventive effect of SGLT2 inhibitors against contrast-associated acute kidney injury in the diabetic population who underwent coronary angiography with a diagnosis of stable angina or acute coronary syndrome. Methods: This was a cross-sectional and single-center study. We enrolled 345 patients with type II diabetes mellitus who were divided into 2 groups: using an SGLT2 inhibitor (group 1; n = 133) in addition to other antidiabetic medication and not using an SGLT2 inhibitor (group 2; n = 212). Both groups were compared in terms of contrast-associated acute kidney injury incidence. We also compared groups for the duration of hospitalization. Results: Baseline characteristics (age, sex, risk factors and medications) and laboratory findings were similar between the 2 groups. The means of administered contrast volume were also similar (160.42 (± 70.31) mL vs. 158.72 (± 81.24) mL, P = 0.83) between groups 1 and 2, respectively. We found that contrast-associated acute kidney injury incidence was significantly higher in group 2 compared to group 1 (n = 56 (26.4%) vs. n = 12 (9.0%), P < 0.001). The duration of hospitalization was significantly longer in group 2 (3.25 (± 2.03) days) than in group 1 (2.54 (± 1.39) days) (P = 0.001). Conclusion: We found that contrast-associated acute kidney injury was significantly lower, and the duration of hospitalization was significantly shorter in diabetic patients using SGLT2 inhibitors compared to non-users.

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Section: Discussionsupporting

confidence: 78%

Do Sodium-Glucose Cotransporter 2 Inhibitors Decrease the Risk of Contrast-Associated Acute Kidney Injury in Patients with Type II Diabetes Mellitus?

Çabuk

2024

Anatol J Cardiol

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“…Finally, we had 7 studies ( 22 – 28 ) included in our review ( Table 1 ). Notably, two papers ( 22 , 23 ) reported their outcomes with some differences, but the population included was the same. Consequently, in our meta-analysis of these two papers, we only considered the one that reported renal outcomes with more detail ( 23 ).…”

Section: Resultsmentioning

confidence: 99%

“…Notably, two papers ( 22 , 23 ) reported their outcomes with some differences, but the population included was the same. Consequently, in our meta-analysis of these two papers, we only considered the one that reported renal outcomes with more detail ( 23 ). Subsequently, we excluded the studies conducted by Bernardini F et al.…”

Section: Resultsmentioning

confidence: 99%

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SGLT-2 inhibitors and prevention of contrast-induced nephropathy in patients with diabetes undergoing coronary angiography and percutaneous coronary interventions: systematic review and meta-analysis

Meregildo-Rodriguez,

Asmat-Rubio,

Vásquez-Tirado

2023

Front. Endocrinol.

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IntroductionSGLT2 inhibitors (SGLT2Is) have demonstrated cardioprotective and nephroprotective effects in patients with and without diabetes. Recent studies suggest that SGLT2Is may reduce the risk of contrast-induced nephropathy (CIN) in patients with diabetes undergoing coronary arteriography (CAG) or percutaneous coronary interventions (PCI). However, the evidence is still inconclusive. We aimed to systematically review the evidence regarding the potential nephroprotective role of SGLT2Is in preventing CIN in this population.MethodsWe searched for studies in six databases published up to September 30, 2023, following a PECO/PICO strategy. Initially, we meta-analyzed five studies, but due to several reasons, mainly methodological concerns, we excluded one RCT. In our final meta-analysis, we included four observational studies.ResultsThis meta-analysis comprised 2,572 patients with diabetes undergoing CAG or PCI, 512 patients treated with SGLT2Is, and 289 events of CIN. This is the first meta-analysis demonstrating that SGLT2Is may reduce the risk of developing CIN by up to 63% (RR 0.37; 95% CI 0.24–0.58) in patients with diabetes undergoing CAG or PCI, compared to not using SGLT2Is. Statistical heterogeneity was not significant (I2 = 0%, p = 0.91). We assessed the certainty of the evidence of this systematic review and meta-analysis, according to the GRADE criteria, as moderate.ConclusionSGLT2Is significantly reduce the risk of CIN by up to 63% in patients with diabetes undergoing CAG or PCI. Clinical trials are needed; several are already underway, which could confirm our findings and investigate other unresolved issues, such as the optimal dose, type, and duration of SGLT2 inhibitor therapy to prevent CIN.Systematic ReviewPROSPERO, identifier CRD42023412892.

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“…Results of recent clinical studies summarised in a metaanalysis of 13 trials including over 90,000 patients documented that chronic sodium-glucose cotransporter 2 inhibitor (SGLT2i) treatment reduced the risk of AKI both in patients with and without diabetes [ 42 ]. Results of recent observational studies suggest that chronic use of SGLT2i reduces the risk of PC-AKI [ 43 , 44 ]. Results of an experimental study suggest that the mechanism of this phenomenon is related to the improvement of tubular cell metabolism related to decreased oxygen consumption in renal proximal tubular cells [ 44 ].…”

Section: Nephroprotective Measures In High-risk Patientsmentioning

confidence: 99%

The use of intravascular contrast media in patients with impaired kidney function – joint clinical practice position statement of the Polish Society of Nephrology and the Polish Medical Society of Radiology

Chmielewski,

Serafin,

Kamińska

et al. 2024

Pol J Radiol

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Radiological procedures utilising intravascular contrast media (ICM) are fundamental to modern medicine, enhancing diagnostics and treatment in diverse medical fields. However, the application of ICM has been constrained in patients with compromised kidney function due to perceived nephrotoxic risks, called contrast-induced nephropathy or contrast-induced acute kidney injury. Historical evidence marked ICM as a possible contributor to kidney damage. This led to restrictive guidelines advocating limited ICM use in patients with impaired renal function, preventing crucial radiographic interventions in patients with acute kidney injury (AKI) and chronic kidney disease. Recent advances challenge these traditional views. In particular, no direct causal relationship has been confirmed between contrast administration and elevated serum creatinine concentrations in humans. Furthermore, contemporary research models and meta-analyses do not associate AKI with contrast usage. This paper, prepared by a cross-disciplinary team of nephrologists and radiologists, presents updated guidelines for ICM application amid renal function impairments, emphasising the reduced nephrotoxic risks currently understood and loosening the previous restrictive approach in patients with renal dysfunction.

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Impact of SGLT2-inhibitors on contrast-induced acute kidney injury in diabetic patients with acute myocardial infarction with and without chronic kidney disease: Insight from SGLT2-I AMI PROTECT registry

Cited by 32 publications

References 31 publications

Do Sodium-Glucose Cotransporter 2 Inhibitors Decrease the Risk of Contrast-Associated Acute Kidney Injury in Patients with Type II Diabetes Mellitus?

Do Sodium-Glucose Cotransporter 2 Inhibitors Decrease the Risk of Contrast-Associated Acute Kidney Injury in Patients with Type II Diabetes Mellitus?

SGLT-2 inhibitors and prevention of contrast-induced nephropathy in patients with diabetes undergoing coronary angiography and percutaneous coronary interventions: systematic review and meta-analysis

The use of intravascular contrast media in patients with impaired kidney function – joint clinical practice position statement of the Polish Society of Nephrology and the Polish Medical Society of Radiology

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